Organization Name: | RIVERDALE PEDIATRIC DENTISTRY P.A. |
NPI Number: | 1053690198 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DARCY JAY RINDELAUB (PEDIATRIC DENTIST) |
Mailing Address: | 3585 124th Ave Nw Ste 400 Coon Rapids |
State: | MN US |
Postal Code: | 554331006 |
Phone Number: | 7637671524 |
Fax Number: | 7637671528 |
NPI Enumeration Date: | 08/07/2011 |
NPI Last Update Date: | 08/07/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | D11365 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |